Provider Demographics
NPI:1184867137
Name:NOEL MORA, M.D., P.A.
Entity Type:Organization
Organization Name:NOEL MORA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-437-0345
Mailing Address - Street 1:13782 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2621
Mailing Address - Country:US
Mailing Address - Phone:954-437-0345
Mailing Address - Fax:
Practice Address - Street 1:13782 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2621
Practice Address - Country:US
Practice Address - Phone:954-437-0345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71747207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261099000Medicaid
FL261099000Medicaid
FLG57239Medicare UPIN